The fasting glucose level and cholesterol are not lowering after taking medicines. Please help.

Hi,

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I have read your query and seen laboratory report (attachment removed to protect patient identity). There is a high HbA1c level which is 11.8 and shows poor control of blood sugar level. BMI is 26.8 which shows that there is a trend towards obesity. Although she is overweight at present as per BMI. There is high blood cholesterol, total cholesterol as well as LDL cholesterol. These are risk factors for cardiovascular diseases. There is a good thing that other laboratory tests are normal. There is no microalbuminuria. GFR (glomerular filtration rate) is normal. Full blood count and renal function tests are normal.

Management of the patient includes diet and lifestyle modification. Regular brisk walk at least 30 minutes a day. She should be on Insulin at least twice a day (mixed NPH and regular like premixed NPH/regular 70%/30%). The exact dosage to be adjusted according to blood sugar level taken at least two to three times daily. A starting regimen may be 20 units in the morning before breakfast and 16 units in the evening before dinner of premixed NPH/regular insulin, the dose can be adjusted keeping in view daily blood sugar and lifestyle of the patient. The patient regular follow-up and consultation unless blood sugar is controlled. Blood cholesterol if not controlled on diet should be treated with the statin. I hope she gets better with the treatment.